Peripheral Vascular Disease - PowerPoint PPT Presentation

Peripheral Vascular Disease. Arterial/Venous: Acute/Chronic. Peripheral Vascular Disease. A term used to describe a group of diseases that involve pathophysiological changes in the “peripheral” arteries (i.e., excluding the coronary arteries) or veins resulting in blood flow disturbances.

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characterized by bilateral intermittent arteriolar vasoconstriction/vasospasm in the hands and feet, often precipitated by emotional factors, cold, tobacco, causing color (white to blue to red) and temperature changes as well as burning pain in affected digits

is usually associated with underlying systemic disease (e.g., autoimmune disorders)

Patients at risk — Based in part upon the above observations, the 2005 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on PAD, which were produced in collaboration with major vascular medicine, vascular surgery, and interventional radiology societies, identified the following groups at risk for lower extremity PAD

anticoagulation effect achieved by preventing the activation of clotting factor IX and by inhibiting the action of thrombin in forming fibrin threads, drug of choice in thromboembolic disease, 4-hour half-life and, in the event of bleeding, is stopped immediately

contraindicated in bleeding disorders or in disorders that increase the risk of bleeding, (e.g., severe hypertension, recent neurosurgery, active GI ulcer, cerebrovascular hemorrhage, and overt bleeding from the GI, GU, or respiratory tract)

The coagulation cascade has two pathways which lead to fibrin formation. These are the contact activation pathway (also known as the intrinsic pathway), and the tissue factor pathway (also known as the extrinsic pathway). It was previously thought that the coagulation cascade consisted of two pathways of equal importance joined to a common pathway. It is now known that the primary pathway for the initiation of blood coagulation is the tissue factor pathway. The aPTT (Activated Partial Thromboplastin Time [APTT]) in contrast to the PT, measures the activity of the intrinsic and common pathways of coagulation.

The division of the clotting cascade into the intrinsic, extrinsic and common pathways. The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. INR, the result (in seconds) for a prothrombin time performed on a normal individual will vary according to the type of analytical system employed, INR = (patient PT/mean normal PT)ISI... International Sensitivity Index (ISI)

Takes about 5 days to work, Needs monitoring (INR), initially frequently (every 2 days), but as levels stabilize can be less frequent, Needs overlap with heparin initially

Major side effect is bleeding, No contact sports, no mountain biking, use helmets, If head injury, see doctor immediately, Tell doctor if procedure or surgery planned, Do not take ASA, NSAIDS,etc

Do not use in pregnancy (use birth control), teratogenic, Can be affected by other meds (antibiotics), Can be affected by diet (keep diet stable – no excess in greens, no nee to avoid completely, but don’t increase consumption dramatically)

Reflects the end stage of chronic venous insufficiency whereby prolonged venous pressure prevents nutrient blood flow, depriving cells of needed oxygen, glucose, and other substances and therefore breakdown in the form of ulcers